Application for Senior Administrative Law Judge & Geographic Preference Statement for Senior Administrative Law Judge

ICR 202106-3206-001

OMB: 3206-0248

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Supplementary Document
2021-08-23
Supporting Statement A
2021-06-24
Supplementary Document
2021-06-16
Supplementary Document
2021-06-16
ICR Details
3206-0248 202106-3206-001
Received in OIRA 201805-3206-004
OPM
Application for Senior Administrative Law Judge & Geographic Preference Statement for Senior Administrative Law Judge
Revision of a currently approved collection   No
Regular 09/09/2021
  Requested Previously Approved
36 Months From Approved 09/30/2021
350 350
161 161
7,899 0

OPM 1655 and OPM 1655A will be used by retired Administrative Law Judges seeking reemployment to complete hearings in accordance with the Administrative Procedures Act of 1946. These forms streamline the application process by providing all needed information on 2 forms. The forms have changed to only to include updated regional selections.

US Code: 5 USC 3323(b)
  
None

Not associated with rulemaking

  86 FR 26966 05/18/2021
86 FR 47168 08/23/2021
No

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 350 350 0 0 0 0
Annual Time Burden (Hours) 161 161 0 0 0 0
Annual Cost Burden (Dollars) 7,899 0 0 7,899 0 0
No
No

$5,794
No
    Yes
    Yes
No
No
No
No
Charles Conyers 202 606-0125 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/09/2021


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